Breastfeeding Twins

  • By Karen Gromada, MSN, RN, IBCLC, FILCA

Finding out you are having more than 1 baby can be both exciting and a bit scary. Some birth and baby plans may change, but you should still plan to breastfeed. Most women can make plenty of milk for twins, triplets, or more. Each baby needs your milk. It is the ideal food to help baby grow. It also helps baby fight infections. Many mothers say breastfeeding helped them get to know each baby as a special person.

Before your babies are born—plan ahead

  • Promise yourself that you will breastfeed (or express your milk if babies are born early).
  • Set a goal to stick with breastfeeding (or expressing milk) for at least the first 6 weeks.
  • Learn as much as you can about breastfeeding. The basics are the same whether feeding 1 baby or 4, because each baby is an individual.
  • Plan to begin breastfeeding in all kinds of situations. Multiples are often born early, and their mothers are more likely to have health issues when pregnant.
  • Ask whether there are breast pumps you can use in the hospital if needed. Ask where to rent a pump for use at home.
  • Line up help for when the babies come home. The best ways for others to help are by making meals, doing laundry, cleaning, or caring for an older child.
  • Tell those close to you that you need them to be your cheerleaders! When others are positive about breastfeeding, you will feel positive too!
  • Shop for a baby doctor. Before the babies are born, find a doctor who has cared for many other breastfeeding twins and triplets. How to get off to the best possible breastfeeding start Full-term (or almost full-term) healthy twins or triplets.

How to get off to the best possible breastfeeding start
Full-term (or almost full-term) healthy twins or triplets

  • Ask to have all of your babies placed skin-toskin on your chest after their birth. Each baby will “tell” you when he or she is ready to breastfeed for the first time. This is often (usually) within 30 to 90 minutes of.
  • By the first or second day after birth, each baby should be waking and “asking” to breastfeed at least 8 to 10 times every 24 hours. Each baby should also be able to keep sucking for at least 10 minutes.
  • Each baby may have a different breastfeeding “style,” which may be confusing! One may suck more strongly than another. One may need more feedings than another. One may feed longer than another.
  • Watch how each baby breastfeeds separately. Not all babies breastfeed the same way.
  • A baby who often falls asleep after breastfeeding for less than 5 minutes may be having problems.
  • Make a chart for each baby. Keep track of feedings, wet diapers, and stools (poop). This will help you know whether all are doing well or whether a baby is having problems.
  • ​One baby may breastfeed really well. Another may have some problems.


Premature, premie, or late preterm multiples (see box)

  • Premie babies may have to spend days to weeks in a NICU or special care nursery.
  • Late preterm babies may do well enough to be in your room or go home with you. Still, 1 or more may not be ready to get enough milk just by breastfeeding. It may take days or weeks before all are able to breastfeed well.
  • Don’t worry if 1 or all babies cannot yet breastfeed well. Each baby will be on his or her own timetable. Soon each baby will grow and be strong enough to do well at breast!
  • Sometimes 1 baby is sent home before the others. You will still want to spend time with each baby. If you cannot visit a baby in the hospital often, call and talk to your baby’s nurse once or more a day until that baby is home.
  • It is not always easy to figure out when each baby is ready to breastfeed without supplements. Often 1 baby is ready before the others.
  • Spend time every day holding each baby skin-to-skin on your chest. (You may hold 2 or 4 at the same time!) A baby will find the breast on his or her own when hungry. This is the best way to know when a baby is ready for more breastfeeding.
  • You will have more time for skin contact, “practice” breastfeedings, or pumping milk if you let helpers give any not-at-breast supplements to 1 or more babies.

Expressing your milk

  • Begin to express your milk by hand or breast pump as soon as possible if:
    •  babies are born early
    • any baby has a breastfeeding problem.
    • you have a health problem that makes it hard to breastfeed all babies as often as needed.
  • Express milk after skin-to-skin contact to help you get more milk.
  • Saving time is important when expressing milk for 1 or more babies! You will likely get more milk in less time when using a rental electric, hospital-grade breast pump.
  • Pump 8 to 10 times for 10 to 20 minutes during every 24 hours.
  • When 1 baby breastfeeds well, save time by pumping 1 breast while feeding with the other.
  • Keep pumping until each baby breastfeeds well 8 or more times in 24 hours and gains weight well. It is common to have to pump during the first few weeks after the birth of multiples.
  • Stay in touch with a lactation consultant (LC) and a breastfeeding support group leader. You will need both ideas and support at times.
  • Ask an LC to help you change a breastfeeding or breast-pumping plan if the current plan is not working well. She can also help you know when and how to cut back on pumping or topping off feedings as each baby learns to breastfeed well.

It isn’t always easy, but be patient. Many mothers of multiples have made up for a slow breastfeeding start. You can too! The column writer is author of Mothering Multiples: Breastfeeding and Caring for Twins or More (3rd rev ed).